Healthcare Provider Details

I. General information

NPI: 1164831509
Provider Name (Legal Business Name): JENNIFER FOLEY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2014
Last Update Date: 10/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7972 W JEFFERSON BLVD STE A
FORT WAYNE IN
46804-4140
US

IV. Provider business mailing address

7972 W JEFFERSON BLVD STE A
FORT WAYNE IN
46804-4140
US

V. Phone/Fax

Practice location:
  • Phone: 260-459-1780
  • Fax: 260-459-2779
Mailing address:
  • Phone: 260-459-1780
  • Fax: 260-459-2779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28161601A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number71005163A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71005163A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: